For the remainder, keepers were paid either by the families and friends of inmates or by the parish authorities.
Two months later, the Bridewell Governors, who had until then shown little interest in the management of Bethlem beyond the appointment of keepers, conducted an inspection of the hospital and a census of its inhabitants for the first time in over 40 years.
The committee of inspection found 21 inmates with only two having been admitted during the previous 12 months.
Precisely dating its transition to this role is difficult.
From 1330 it was routinely referred to as a "hospital" but that does not necessarily indicate a change in its primary role from alms collection – the word "hospital" could as likely have been used to denote a lodging for travellers, equivalent to a hostel, and could have described an institution acting as a centre and providing accommodation for peregrinating alms-seekers or questores.
And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man It has also been the continent's most famous, and infamous, specialist institution for the care and treatment of the insane.
Its popular designation – "Bedlam" – has long been synonymous with madness.
The memory of its foundation became muddied and muddled; in 1381 the royal candidate for the post of master claimed that from its beginnings it had been superintended by an order of knights and he confused its founder, Goffredo de Prefetti, with the Frankish crusader, Godfrey de Bouillon.
Following a brief interval when it was placed under the management of the governors of Christ's Hospital, from 1557 it was administered by the governors of Bridewell, a prototype house of correction at Blackfriars.
This was significant as, throughout the reign of Edward III (1327–77), the English monarchy had extended its patronage over ecclesiastical positions through the seizure of priories under the control of non-English religious houses.